Factors Associated with Extended-Spectrum β-Lactamases and Carbapenem-Resistant Bloodstream Infections: A Five-Year Retrospective Study

Overview

Journal Pathogens

Date 2023 Nov 25

PMID 38003742

Authors

Andreas G Tofarides

Panagiotis Dimitriou

Georgios K Nikolopoulos

Dimitrios Rogkas

Christina Flourou

Elina Khattab

Diamanto Kasapi

Chara Azina

Eirini Christaki

Affiliations

Soon will be listed here.

Abstract

is one of the leading causes of nosocomial infections. It has been estimated that nosocomial infection by comprises 3-8% of all nosocomial infections. bloodstream infections (BSIs) occur worldwide with varying mortality. Resistant strains, like those producing extended-spectrum beta-lactamases (ESBL) and carbapenemases, are becoming increasingly common, especially in hospital settings, posing therapeutic challenges. In this article, we aimed to study the epidemiology and risk factors of BSIs due to resistant strains in the period 1 January 2014-31 December 2018 at the Nicosia General Hospital, the largest tertiary hospital in Cyprus. Data on demographics, co-morbidities, prior hospitalization, prior intensive care unit (ICU) admission, previous antimicrobial use, nosocomial acquisition of the infection, the presence of a prosthetic device or surgery, and the primary site of infection were retrospectively recorded. Associations between the detection of ESBL BSIs and factors/covariates were examined using logistic regression. This study involved 175 patients with BSI caused by . Of these, 61 BSIs were caused by ESBL strains, 101 by non-ESBL, and 13 by carbapenem-resistant (CR) strains. In univariable analyses, age, sex, heart disease, antimicrobial use during current admission, previous hospitalization (ward or ICU), and primary BSI were associated with the presence of an ESBL strain. Antibiotic use during current admission and heart disease remained statistically significantly associated with ESBL BSI in multivariable models. Antibiotic use during current admission, respiratory infection, and a recent history of surgery were more prevalent among CR BSI patients than among non-CR BSI patients. Our study showed that recent antimicrobial use and heart disease were associated with BSI due to ESBL-producing . This finding could inform clinical practice in hospital settings.

References

Yuan Y, Wang J, Yao Z, Ma B, Li Y, Yan W . Risk Factors for Carbapenem-Resistant Bloodstream Infections and Outcomes. Infect Drug Resist. 2020; 13:207-215. PMC: 6985980. DOI: 10.2147/IDR.S223243. View

Soares de Moraes L, Magalhaes G, Soncini J, Pelisson M, Perugini M, Vespero E . High mortality from carbapenem-resistant Klebsiella pneumoniae bloodstream infection. Microb Pathog. 2022; 167:105519. DOI: 10.1016/j.micpath.2022.105519. View

Zhu W, Yuan Z, Zhou H . Risk factors for carbapenem-resistant Klebsiella pneumoniae infection relative to two types of control patients: a systematic review and meta-analysis. Antimicrob Resist Infect Control. 2020; 9(1):23. PMC: 6995231. DOI: 10.1186/s13756-020-0686-0. View

Liu B, Yi H, Fang J, Han L, Zhou M, Guo Y . Antimicrobial resistance and risk factors for mortality of pneumonia caused by among diabetics: a retrospective study conducted in Shanghai, China. Infect Drug Resist. 2019; 12:1089-1098. PMC: 6511257. DOI: 10.2147/IDR.S199642. View

Albiger B, Glasner C, Struelens M, Grundmann H, Monnet D . Carbapenemase-producing Enterobacteriaceae in Europe: assessment by national experts from 38 countries, May 2015. Euro Surveill. 2015; 20(45). DOI: 10.2807/1560-7917.ES.2015.20.45.30062. View

Quan J, Zhao D, Liu L, Chen Y, Zhou J, Jiang Y . High prevalence of ESBL-producing Escherichia coli and Klebsiella pneumoniae in community-onset bloodstream infections in China. J Antimicrob Chemother. 2016; 72(1):273-280. DOI: 10.1093/jac/dkw372. View

Tian L, Tan R, Chen Y, Sun J, Liu J, Qu H . Epidemiology of bloodstream infections in a teaching hospital: factors related to the carbapenem resistance and patient mortality. Antimicrob Resist Infect Control. 2016; 5:48. PMC: 5114729. DOI: 10.1186/s13756-016-0145-0. View

Huang C, Tsai J, Chen I, Hsu B, Huang M, Huang Y . Risk factors for in-hospital mortality in patients with type 2 diabetes complicated by community-acquired Klebsiella pneumoniae bacteremia. J Formos Med Assoc. 2015; 114(10):916-22. DOI: 10.1016/j.jfma.2015.07.011. View

van der Eerden M, Vlaspolder F, de Graaff C, Groot T, Jansen H, Boersma W . Value of intensive diagnostic microbiological investigation in low- and high-risk patients with community-acquired pneumonia. Eur J Clin Microbiol Infect Dis. 2005; 24(4):241-9. DOI: 10.1007/s10096-005-1316-8. View

10.

Li D, Huang X, Rao H, Yu H, Long S, Li Y . bacteremia mortality: a systematic review and meta-analysis. Front Cell Infect Microbiol. 2023; 13:1157010. PMC: 10159367. DOI: 10.3389/fcimb.2023.1157010. View

11.

Schaberg D, Culver D, Gaynes R . Major trends in the microbial etiology of nosocomial infection. Am J Med. 1991; 91(3B):72S-75S. DOI: 10.1016/0002-9343(91)90346-y. View

12.

Nguyen M, Toye B, Kanji S, Zvonar R . Risk Factors for and Outcomes of Bacteremia Caused by Extended-Spectrum ß-Lactamase-Producing Escherichia coli and Klebsiella Species at a Canadian Tertiary Care Hospital. Can J Hosp Pharm. 2015; 68(2):136-43. PMC: 4414075. DOI: 10.4212/cjhp.v68i2.1439. View

13.

Tsay R, Siu L, Fung C, Chang F . Characteristics of bacteremia between community-acquired and nosocomial Klebsiella pneumoniae infection: risk factor for mortality and the impact of capsular serotypes as a herald for community-acquired infection. Arch Intern Med. 2002; 162(9):1021-7. DOI: 10.1001/archinte.162.9.1021. View

14.

Palacios-Baena Z, Giannella M, Manissero D, Rodriguez-Bano J, Viale P, Lopes S . Risk factors for carbapenem-resistant Gram-negative bacterial infections: a systematic review. Clin Microbiol Infect. 2020; 27(2):228-235. DOI: 10.1016/j.cmi.2020.10.016. View

15.

Hansen D, Gottschau A, Kolmos H . Epidemiology of Klebsiella bacteraemia: a case control study using Escherichia coli bacteraemia as control. J Hosp Infect. 1998; 38(2):119-32. DOI: 10.1016/s0195-6701(98)90065-2. View

16.

Asri N, Ahmad S, Mohamud R, Mohd Hanafi N, Mohd Zaidi N, Irekeola A . Global Prevalence of Nosocomial Multidrug-Resistant : A Systematic Review and Meta-Analysis. Antibiotics (Basel). 2021; 10(12). PMC: 8698758. DOI: 10.3390/antibiotics10121508. View

17.

Mandell L, Wunderink R, Anzueto A, Bartlett J, Campbell G, Dean N . Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults. Clin Infect Dis. 2007; 44 Suppl 2:S27-72. PMC: 7107997. DOI: 10.1086/511159. View

18.

Cao Z, Yue C, Kong Q, Liu Y, Li J . Risk Factors for a Hospital-Acquired Carbapenem-Resistant Bloodstream Infection: A Five-Year Retrospective Study. Infect Drug Resist. 2022; 15:641-654. PMC: 8887613. DOI: 10.2147/IDR.S342103. View

19.

Farhadi M, Ahanjan M, Goli H, Haghshenas M, Gholami M . High frequency of multidrug-resistant (MDR) Klebsiella pneumoniae harboring several β-lactamase and integron genes collected from several hospitals in the north of Iran. Ann Clin Microbiol Antimicrob. 2021; 20(1):70. PMC: 8479884. DOI: 10.1186/s12941-021-00476-1. View

20.

Xu L, Sun X, Ma X . Systematic review and meta-analysis of mortality of patients infected with carbapenem-resistant Klebsiella pneumoniae. Ann Clin Microbiol Antimicrob. 2017; 16(1):18. PMC: 5371217. DOI: 10.1186/s12941-017-0191-3. View